Scholars@Duke
Susan Nicole Hastings

Susan Nicole Hastings

Professor of Medicine
Medicine, Geriatrics and Palliative Care
susan.hastings@duke.edu
Duke Box 3003, Durham, NC 27710
MC 152, HSR&D, Durham VAMC, 508 Fulton St, Durham, NC 27710
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Selected Publications

Fall Outcomes in Older Adults Following Benzodiazepine/Z-Drug Discontinuation: A Retrospective Cohort Study in an Academic Health System.

Journal Article Drugs Aging · September 18, 2024 BACKGROUND: Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications. OBJECTIVE: In a retrospective cohort study of older adults with chroni ... Full text Link to item Cite

Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis.

Journal Article Acad Emerg Med · September 12, 2024 INTRODUCTION: Older adults are at high risk of adverse health outcomes in the post-emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribut ... Full text Link to item Cite

Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage.

Journal Article Ann Emerg Med · September 2024 STUDY OBJECTIVE: We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage. METHODS: We conducted a ... Full text Link to item Cite

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

Journal Article Journal of the American Geriatrics Society · September 2024 BackgroundEmergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-p ... Full text Cite

Veterans' use of inpatient and outpatient palliative care: The national landscape.

Journal Article J Am Geriatr Soc · August 23, 2024 BACKGROUND: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpat ... Full text Link to item Cite

Is more care recipient time at home also a family caregiver-centered quality of life measure?

Journal Article J Am Geriatr Soc · August 13, 2024 BACKGROUND: Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, an ... Full text Link to item Cite

A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

Journal Article Health Serv Res · August 13, 2024 OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and fa ... Full text Link to item Cite

Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial.

Journal Article Health Serv Res · August 8, 2024 OBJECTIVE: To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES). DATA SOURCES AND STUDY SETTING: iHI-FIVES was delivered to caregivers at eight Veterans Affairs ... Full text Link to item Cite

Allostatic Load, Morbidity, and Mortality Among Older Adults: A Multi-Wave Analysis From the National Health and Aging Trends Study.

Journal Article J Appl Gerontol · August 2024 Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitu ... Full text Link to item Cite

Factors influencing central nervous system medication deprescribing and behavior change in hospitalized older adults.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: Central nervous system (CNS) medications are linked to higher morbidity and mortality in older adults. Hospitalization allows for deprescribing opportunities. This qualitative study investigates clinician and patient perspectives on CNS medicat ... Full text Link to item Cite

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program ... Full text Link to item Cite

Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling.

Journal Article Health Serv Res · August 1, 2024 OBJECTIVE: To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medic ... Full text Link to item Cite

Site-initiated adaptations in the implementation of an evidence-based inpatient walking program.

Journal Article J Am Geriatr Soc · July 29, 2024 BACKGROUND: There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could con ... Full text Link to item Cite

Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration.

Journal Article PM R · July 5, 2024 INTRODUCTION: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed t ... Full text Link to item Cite

Factors Associated With Hospital Admission in the Last Month: A Retrospective Single Center Analysis.

Journal Article J Pain Symptom Manage · June 2024 CONTEXT: Driven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life. OBJECTIVE: To evaluate patient facto ... Full text Link to item Cite

Central nervous system medication use around hospitalization.

Journal Article J Am Geriatr Soc · June 2024 BACKGROUND: Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, discontinuations, and user profiles during hospitalization periods. METH ... Full text Link to item Cite

Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis.

Journal Article JMIR Res Protoc · May 10, 2024 BACKGROUND: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. OBJECTIVE: This study aimed to better understand how families are involved in the care of hospitalized o ... Full text Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA health forum · May 2024 ImportanceComprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to e ... Full text Cite

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program.

Journal Article Health Serv Res · April 17, 2024 OBJECTIVE: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults. DATA SOURCES AND ST ... Full text Link to item Cite

Fall Outcomes in Older Adults Following Benzodiazepine/Z-Drug Discontinuation: A Retrospective Cohort Study in an Academic Health System.

Journal Article Drugs Aging · September 18, 2024 BACKGROUND: Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications. OBJECTIVE: In a retrospective cohort study of older adults with chroni ... Full text Link to item Cite

Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis.

Journal Article Acad Emerg Med · September 12, 2024 INTRODUCTION: Older adults are at high risk of adverse health outcomes in the post-emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribut ... Full text Link to item Cite

Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage.

Journal Article Ann Emerg Med · September 2024 STUDY OBJECTIVE: We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage. METHODS: We conducted a ... Full text Link to item Cite

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

Journal Article Journal of the American Geriatrics Society · September 2024 BackgroundEmergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-p ... Full text Cite

Veterans' use of inpatient and outpatient palliative care: The national landscape.

Journal Article J Am Geriatr Soc · August 23, 2024 BACKGROUND: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpat ... Full text Link to item Cite

Is more care recipient time at home also a family caregiver-centered quality of life measure?

Journal Article J Am Geriatr Soc · August 13, 2024 BACKGROUND: Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, an ... Full text Link to item Cite

A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

Journal Article Health Serv Res · August 13, 2024 OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and fa ... Full text Link to item Cite

Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial.

Journal Article Health Serv Res · August 8, 2024 OBJECTIVE: To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES). DATA SOURCES AND STUDY SETTING: iHI-FIVES was delivered to caregivers at eight Veterans Affairs ... Full text Link to item Cite

Allostatic Load, Morbidity, and Mortality Among Older Adults: A Multi-Wave Analysis From the National Health and Aging Trends Study.

Journal Article J Appl Gerontol · August 2024 Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitu ... Full text Link to item Cite

Factors influencing central nervous system medication deprescribing and behavior change in hospitalized older adults.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: Central nervous system (CNS) medications are linked to higher morbidity and mortality in older adults. Hospitalization allows for deprescribing opportunities. This qualitative study investigates clinician and patient perspectives on CNS medicat ... Full text Link to item Cite

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program ... Full text Link to item Cite

Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling.

Journal Article Health Serv Res · August 1, 2024 OBJECTIVE: To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medic ... Full text Link to item Cite

Site-initiated adaptations in the implementation of an evidence-based inpatient walking program.

Journal Article J Am Geriatr Soc · July 29, 2024 BACKGROUND: There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could con ... Full text Link to item Cite

Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration.

Journal Article PM R · July 5, 2024 INTRODUCTION: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed t ... Full text Link to item Cite

Factors Associated With Hospital Admission in the Last Month: A Retrospective Single Center Analysis.

Journal Article J Pain Symptom Manage · June 2024 CONTEXT: Driven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life. OBJECTIVE: To evaluate patient facto ... Full text Link to item Cite

Central nervous system medication use around hospitalization.

Journal Article J Am Geriatr Soc · June 2024 BACKGROUND: Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, discontinuations, and user profiles during hospitalization periods. METH ... Full text Link to item Cite

Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis.

Journal Article JMIR Res Protoc · May 10, 2024 BACKGROUND: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. OBJECTIVE: This study aimed to better understand how families are involved in the care of hospitalized o ... Full text Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA health forum · May 2024 ImportanceComprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to e ... Full text Cite

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program.

Journal Article Health Serv Res · April 17, 2024 OBJECTIVE: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults. DATA SOURCES AND ST ... Full text Link to item Cite

Comprehensive Caregiver Supports and Ascertainment and Treatment of Veteran Pain.

Journal Article Med Care Res Rev · April 2024 Disabled Veterans commonly experience pain. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides training, a stipend, and services to family caregivers of eligible Veterans to support their caregiving role. We compared ascertainme ... Full text Link to item Cite

Understanding veterans' experiences with lung cancer and psychological distress: A multimethod approach.

Journal Article Psychol Serv · March 4, 2024 Psychological distress while coping with cancer is a highly prevalent and yet underrecognized and burdensome adverse effect of cancer diagnosis and treatment. Left unaddressed, psychological distress can further exacerbate poor mental health, negatively in ... Full text Open Access Link to item Cite

If You Build It, Will They Come? Patient and Provider Use of a Novel Hybrid Telehealth Care Pathway for Low Back Pain.

Journal Article Phys Ther · February 1, 2024 OBJECTIVE: The purpose of this study was to describe the referrals and use of a hybrid care model for low back pain that includes on-site care by physical therapists, physical activity training, and psychologically informed practice (PiP) delivered by tele ... Full text Link to item Cite

Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial.

Journal Article Implement Sci Commun · January 12, 2024 BACKGROUND: STRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, STRIDE was associated with reduced odds of h ... Full text Link to item Cite

"I've been doing this for years": the COVID-19 pandemic and family caregiver isolation and loneliness.

Journal Article Front Aging · 2024 BACKGROUND: Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with finances among other activities. As a result of their caregiving, family caregiv ... Full text Link to item Cite

Organizational Characteristics of Hospitals Meeting STRIDE Program Adoption Benchmarks to Support Mobility for Hospitalized Persons.

Journal Article Inquiry · 2024 There are few validated contextual measures predicting adoption of evidence-based programs. Variation in context at clinical sites can hamper dissemination. We examined organizational characteristics of Veterans Affairs hospitals implementing STRIDE, a hos ... Full text Link to item Cite

Informing a home time measure reflective of quality of life: A data driven investigation of time frames and settings of health care utilization.

Journal Article Health Serv Res · December 2023 OBJECTIVE: To evaluate short- and long-term measures of health care utilization-days in the emergency department (ED), inpatient (IP) care, and rehabilitation in a post-acute care (PAC) facility-to understand how home time (i.e., days alive and not in an a ... Full text Link to item Cite

Emergency Department-to-Community Transitions of Care: Best Practices for the Older Adult Population.

Journal Article Clin Geriatr Med · November 2023 This article describes emergency department (ED)-to-community care transitions for older adults and associated challenges, measurement, proven efficacious and effective interventions, and policy considerations. Older adults experiencing social isolation an ... Full text Link to item Cite

Group physical therapy for knee osteoarthritis: protocol for a hybrid type III effectiveness-implementation trial.

Journal Article Implement Sci Commun · October 12, 2023 BACKGROUND: Knee osteoarthritis (OA) is a leading cause of chronic pain and disability and one of the most common conditions treated in outpatient physical therapy (PT). Because of the high and growing prevalence of knee OA, there is a need for efficient a ... Full text Open Access Link to item Cite

Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial.

Journal Article Clin Trials · October 2023 BACKGROUND/AIMS: Embedded pragmatic clinical trials are increasingly recommended for non-pharmacological pain care research due to their focus on examining intervention effectiveness within real-world settings. Engagement with patients, health care provide ... Full text Open Access Link to item Cite

Optimizing remote access to urinary incontinence treatments for women veterans (PRACTICAL): Study protocol for a pragmatic clinical trial comparing two virtual care options.

Journal Article Contemporary clinical trials · October 2023 ObjectivesIn this pragmatic clinical trial, the primary objective is to increase access to behavioral treatment of urinary incontinence (UI) for women Veterans by comparing the effectiveness of two virtual care delivery modalities.Methods ... Full text Cite

Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study.

Journal Article J Gen Intern Med · September 2023 BACKGROUND: Dementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed. OBJECTIVE: To compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics. DESIGN: Secondary analysis of ... Full text Link to item Cite

Implementation intensification to disseminate a skills-based caregiver training program: protocol for a type III effectiveness-implementation hybrid trial.

Journal Article Implement Sci Commun · August 16, 2023 BACKGROUND: Family caregiver training decreases caregiver psychological burden and improves caregiver depressive symptoms and health-related quality of life. Caregivers FIRST is an evidence-based group skills training curriculum for family caregivers and w ... Full text Link to item Cite

Knowledge, goals, and misperceptions about palliative care in adults with chronic disease or cancer.

Journal Article Palliat Support Care · August 10, 2023 OBJECTIVES: Limited evidence investigates how knowledge, misconceptions, and beliefs about palliative care vary across patients with cancerous versus non-cancerous chronic disease. We examined the knowledge of and misconceptions about palliative care among ... Full text Link to item Cite

Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory.

Journal Article Implement Sci Commun · June 19, 2023 BACKGROUND: Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance pla ... Full text Open Access Link to item Cite

Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial.

Journal Article Ann Intern Med · June 2023 BACKGROUND: In trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions. OBJECTIVE: To evaluate the effect of implementation of a ... Full text Link to item Cite

Social Risk Factors Are Associated With Disability Prevalence - Results From 17 States in the 2017 Behavioral Risk Factor Surveillance System.

Journal Article Am J Health Promot · May 2023 PURPOSE: Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type. DESIGN: The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillanc ... Full text Link to item Cite

Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias

Conference PLoS ONE · May 1, 2023 Introduction/Objective Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could cont ... Full text Cite

Racial inequality in functional trajectories between Black and White U.S. veterans.

Journal Article J Am Geriatr Soc · April 2023 BACKGROUND: Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. Our objectives were to: (1) assess how functional trajectories differed for Black and White Veterans ... Full text Link to item Cite

Patient experiences of a care transition intervention for Veterans to reduce emergency department visits.

Journal Article Acad Emerg Med · April 2023 OBJECTIVES: Care transition interventions (CTIs) are used to improve outcomes after an emergency department (ED) visit. A recent randomized controlled trial of a Veterans Health Administration (VHA) CTI titled Discharge Information and Support for Patients ... Full text Link to item Cite

Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine.

Journal Article Acad Emerg Med · April 2023 To better understand and prioritize research on emergency care for Veterans, the Department of Veteran Affairs (VA) Health Services Research and Development convened the 16th State of the Art Conference on VA Emergency Medicine (SAVE) in Winter 2022 with e ... Full text Link to item Cite

A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program.

Journal Article Acad Emerg Med · April 2023 OBJECTIVES: The Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program involves three core components including provider education, clinical decision support, and audit ... Full text Link to item Cite

Validating administratively derived frailty scores for use in Veterans Health Administration emergency departments.

Journal Article Acad Emerg Med · April 2023 OBJECTIVES: Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. Veterans Health Administration (VA) emergency departments (ED) are the primary venue of car ... Full text Open Access Link to item Cite

Intensification of Implementation Strategies: Developing a Model of Foundational and Enhanced Implementation Approaches to Support National Adoption and Scale-up.

Journal Article Gerontologist · March 21, 2023 Implementation strategies are activities to support integration of evidence-based programs (EBPs) into routine care. Comprised of 170+ facilities, the Veterans Affairs Healthcare System is conducive to evaluating feasibility and scalability of implementati ... Full text Link to item Cite

Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination.

Journal Article Gerontologist · March 21, 2023 BACKGROUND AND OBJECTIVES: A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of ... Full text Open Access Link to item Cite

Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias.

Journal Article PLoS One · 2023 INTRODUCTION/OBJECTIVE: Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could con ... Full text Open Access Link to item Cite

Usability and Acceptability of Social Robot Pets Among Community-Dwelling Veterans Living With Dementia and Their Caregivers.

Journal Article Am J Alzheimers Dis Other Demen · 2023 Social robot pets promote engagement and psychosocial well-being among older adults, yet little is known about their use among community-dwelling Veterans living with dementia. This programmatic evaluation used a within subjects, pre-post design to examine ... Full text Link to item Cite

“Welcome to Our World”: Experiences of Persons Living with Dementia Prior to and During the COVID-19 Pandemic

Journal Article OBM Neurobiology · January 1, 2023 People diagnosed with dementia are experts on living with the disease, yet their perspectives are often overlooked in research and practice. The pandemic has amplified health inequities among older adults, but the impact of the pandemic on the lived experi ... Full text Cite

Development of a Home-Based Stress Management Toolkit for Dementia Caring Dyads: Protocol for a Pilot Intervention Development and Feasibility Study.

Journal Article JMIR Res Protoc · December 14, 2022 BACKGROUND: People living with dementia (PLWD) and their care partners (dementia caring dyads) are at a heightened risk of experiencing stress-related symptoms and conditions. Yet, many dyadic stress management interventions have had limited uptake by heal ... Full text Link to item Cite

Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study.

Journal Article J Gen Intern Med · December 2022 BACKGROUND: Inpatient mobility programs can help older adults maintain function during hospitalization. Changing hospital practice can be complex and require engagement of various staff levels and disciplines; however, we know little about how interprofess ... Full text Link to item Cite

COVID-19 vaccination intention and activation among health care system employees: A mixed methods study.

Journal Article Vaccine · August 19, 2022 BACKGROUND: Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obt ... Full text Open Access Link to item Cite

Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review.

Journal Article J Am Med Dir Assoc · August 2022 OBJECTIVES: We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation. DESIG ... Full text Open Access Link to item Cite

Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review.

Journal Article J Am Med Dir Assoc · August 2022 OBJECTIVES: To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prior ... Full text Link to item Cite

Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness.

Journal Article BMC Health Serv Res · July 29, 2022 BACKGROUND: Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based prac ... Full text Open Access Link to item Cite

Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.

Journal Article JMIR Form Res · July 18, 2022 BACKGROUND: Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and ot ... Full text Open Access Link to item Cite

Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory.

Journal Article Mil Med · July 1, 2022 Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have ... Full text Link to item Cite

Association of Health Literacy and Numeracy With Lupus Knowledge and the Creation of the Lupus Knowledge Assessment Test.

Journal Article J Rheumatol · June 2022 OBJECTIVE: Limited health literacy and numeracy are associated with worse patient-reported outcomes and higher disease activity in systemic lupus erythematosus (SLE), but which factors may mediate this association is unknown. We sought to determine the ass ... Full text Link to item Cite

Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.

Journal Article Geriatrics (Basel) · May 19, 2022 Deprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between antic ... Full text Open Access Link to item Cite

Psychological distress among medically complex veterans with a recent emergency department visit.

Journal Article Psychol Serv · May 2022 Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns ... Full text Link to item Cite

Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States.

Journal Article Prev Chronic Dis · February 17, 2022 INTRODUCTION: Social risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objec ... Full text Open Access Link to item Cite

Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments.

Journal Article Front Health Serv · 2022 BACKGROUND: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is an effective quality improvement program initially designed in the Veterans Administration (VA) health care system to reduce pote ... Full text Open Access Link to item Cite

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement.

Journal Article Acad Emerg Med · December 2021 OBJECTIVES: Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, part ... Full text Link to item Cite

Exploring differential response to an emergency department-based care transition intervention.

Journal Article Am J Emerg Med · December 2021 OBJECTIVE: To identify multivariable subgroups of patients with differential responses to a nurse-delivered care transition intervention after an emergency department (ED) visit in a randomized controlled trial (RCT) using an emerging data-driven method. D ... Full text Link to item Cite

Developing a person-centered, population based measure of "home time": Perspectives of older patients and unpaid caregivers.

Journal Article Healthc (Amst) · December 2021 Measuring "home time," number of days not in facility-based care, with medical claims is a promising approach to assess person-centered outcomes on a population level. Generally, spending more time at home matches long-term care preferences and improves qu ... Full text Link to item Cite

Walking All over COVID-19: The Rapid Development of STRIDE in Your Room, an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic.

Journal Article Geriatrics (Basel) · November 10, 2021 Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United State ... Full text Open Access Link to item Cite

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.

Journal Article BMJ Open Qual · November 2021 Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or ... Full text Open Access Link to item Cite

Evaluation of a geriatrics primary care model using prospective matching to guide enrollment.

Journal Article BMC Med Res Methodol · August 16, 2021 BACKGROUND: Few definitive guidelines exist for rigorous large-scale prospective evaluation of nonrandomized programs and policies that require longitudinal primary data collection. In Veterans Affairs (VA) we identified a need to understand the impact of ... Full text Open Access Link to item Cite

Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities.

Journal Article J Gen Intern Med · August 2021 BACKGROUND: Virtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans' access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Stre ... Full text Open Access Link to item Cite

Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults.

Journal Article J Am Geriatr Soc · July 2021 BACKGROUND: Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE: This qualitative study uses a socioecological framework to explore factors th ... Full text Link to item Cite

Preoperative Care Assessment of Need Scores Are Associated With Postoperative Mortality and Length of Stay in Veterans Undergoing Knee Replacement.

Journal Article Fed Pract · July 2021 BACKGROUND: Care Assessment of Need (CAN) scores predicting 90-day mortality and hospitalization are automatically computed each week for patients receiving care at Veterans Health Administration facilities. While currently used only by primary care teams ... Full text Link to item Cite

Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design.

Journal Article BMC Health Serv Res · May 6, 2021 BACKGROUND: Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge. We describe the application of the Replicating Effective Programs (REP) ... Full text Open Access Link to item Cite

Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization.

Journal Article Med Care · May 1, 2021 OBJECTIVE: Population segmentation has been recognized as a foundational step to help tailor interventions. Prior studies have predominantly identified subgroups based on diagnoses. In this study, we identify clinically coherent subgroups using social dete ... Full text Link to item Cite

Video-Enhanced Care Management for Medically Complex Older Adults with Cognitive Impairment.

Journal Article J Am Geriatr Soc · January 2021 OBJECTIVE: This pilot study assessed feasibility of video-enhanced care management for complex older veterans with suspected mild cognitive impairment (CI) and their care partners, compared with telephone delivery. DESIGN: Pilot randomized controlled trial ... Full text Link to item Cite

Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement.

Journal Article J Elder Abuse Negl · 2021 The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this ... Full text Link to item Cite

Improving Veteran Access to Integrated Management of Back Pain (AIM-Back): Protocol for an Embedded Pragmatic Cluster-Randomized Trial.

Journal Article Pain Med · December 12, 2020 BACKGROUND: Coordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain ... Full text Open Access Link to item Cite

Transforming low back pain care delivery in the United States.

Journal Article Pain · December 2020 Low back pain (LBP) continues to be a challenging condition to manage effectively. Recent guideline recommendations stress providing non-pharmacological care early, limiting diagnostic testing, and reducing exposure to opioid pain medications. However, the ... Full text Link to item Cite

Advancing the science of population-based measures of home-time.

Journal Article Healthc (Amst) · December 2020 The "home time" measure is gaining appeal in evaluating outcomes for multiple patient populations including post-surgery or intervention and the last 6 months of life. Advancing the science of home time measures will require obtaining the perspectives of p ... Full text Link to item Cite

Investigating Health Literacy in Systemic Lupus Erythematosus: a Descriptive Review.

Journal Article Curr Allergy Asthma Rep · November 12, 2020 PURPOSE OF REVIEW: Inadequate health literacy is common among American adults, but little is known about the impact of health literacy in rheumatic diseases. The purpose of this article is to review studies investigating health literacy and its association ... Full text Link to item Cite

Hospitalization Risk Among Older Adults with Sensory Impairments: Development of a Prognostic Model.

Journal Article J Am Geriatr Soc · November 2020 OBJECTIVES: To develop a prognostic model for hospital admissions over a 1-year period among community-dwelling older adults with self-reported hearing and/or vision impairments based on readily obtainable clinical predictors. DESIGN: Retrospective cohort ... Full text Link to item Cite

Implementation of a stepped wedge cluster randomized trial to evaluate a hospital mobility program.

Journal Article Trials · October 16, 2020 BACKGROUND: Stepped wedge cluster randomized trials (SW-CRT) are increasingly used to evaluate new clinical programs, yet there is limited guidance on practical aspects of applying this design. We report our early experiences conducting a SW-CRT to examine ... Full text Open Access Link to item Cite

Mobilizing Hospitals to Mobilize Patients.

Journal Article J Am Geriatr Soc · October 2020 Full text Link to item Cite

Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients.

Journal Article JAMA Netw Open · October 1, 2020 IMPORTANCE: Despite recognition of the association between individual social and behavioral determinants of health (SDH) and patient outcomes, little is known regarding the value of SDH in explaining variation in outcomes for high-risk patients. OBJECTIVE: ... Full text Link to item Cite

Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system.

Journal Article Int J Qual Health Care · September 23, 2020 OBJECTIVES: To present the three-site EQUIPPED academic health system research collaborative, which engaged in sequential implementation of the EQUIPPED medication safety program, as a learning health system; to understand how the organizations worked toge ... Full text Link to item Cite

Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system.

Journal Article Int J Qual Health Care · September 4, 2020 OBJECTIVES: To present the three-site EQUIPPED academic health system research collaborative, which engaged in sequential implementation of the EQUIPPED medication safety program, as a learning health system; to understand how the organizations worked toge ... Full text Link to item Cite

Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis.

Journal Article J Aging Phys Act · April 24, 2020 This study describes the availability of physical activity information in the electronic health record, explores how electronic health record documentation correlates with accelerometer-derived physical activity data, and examines whether measured physical ... Full text Link to item Cite

Implementation of a group physical therapy program for Veterans with knee osteoarthritis.

Journal Article BMC Musculoskelet Disord · February 3, 2020 BACKGROUND: A previous randomized clinical trial found that a Group Physical Therapy (PT) program for knee osteoarthritis yielded similar improvements in pain and function compared with traditional individual PT. Based on these findings the Group PT progra ... Full text Open Access Link to item Cite

Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults.

Journal Article J Am Geriatr Soc · February 2020 BACKGROUND: Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational stu ... Full text Link to item Cite

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention.

Journal Article J Nurs Scholarsh · January 2020 PURPOSE: We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FI ... Full text Link to item Cite

Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial.

Journal Article J Gen Intern Med · January 2020 BACKGROUND: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit. OBJECTIVE: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans t ... Full text Link to item Cite

Cognitive Screening and Dementia Diagnoses in Primary Care Settings

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2020 Cite

NIH-DoD-VA Pain Management Collaboratory.

Journal Article Pain Med · December 1, 2019 Full text Link to item Cite

Family Caregiver Skills Training to Improve Experiences of Care: a Randomized Clinical Trial.

Journal Article J Gen Intern Med · October 2019 OBJECTIVE: To evaluate the effectiveness of Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES), a skills training program for caregivers of persons with functional or cognitive impairments. DESIGN: A two-arm RCT. SETTING: Single Veter ... Full text Link to item Cite

Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults.

Journal Article J Am Geriatr Soc · August 2019 OBJECTIVES: To examine the association between self-reported vision impairment (VI), hearing impairment (HI), and dual-sensory impairment (DSI), stratified by dementia status, on hospital admissions, hospice use, and healthcare costs. DESIGN: Retrospective ... Full text Link to item Cite

Emergency Department Interventions for Older Adults: A Systematic Review.

Journal Article J Am Geriatr Soc · July 2019 OBJECTIVES: To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN: A conceptual model informed, protocol-based systematic review. SETTING: Emergency Department (ED) ... Full text Link to item Cite

Enrollment and Retention of Men and Women in Health Services Research and Development Trials.

Journal Article Womens Health Issues · June 25, 2019 INTRODUCTION: Sex- and gender-specific science is essential to inform patient-centered, evidence-based care. Developing such evidence requires adequate inclusion of both women and men in trials. We sought to describe study participation of women and men in ... Full text Link to item Cite

A Path To High-Quality Team-Based Care For People With Serious Illness.

Journal Article Health Aff (Millwood) · June 2019 Although most care for people with serious illness is delivered by multiple providers and agencies, there is no gold standard for how to assemble, train, unify, and sustain strong teams. Using lessons from complexity science, a way of studying complex syst ... Full text Link to item Cite

An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department.

Journal Article J Pharm Pract · April 2019 OBJECTIVE: To evaluate the impact of an academic detailing intervention delivered as part of a quality improvement project by a physician-pharmacist pair on (1) self-reported confidence in prescribing for older adults and (2) rates of potentially inappropr ... Full text Link to item Cite

Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs.

Journal Article Med Care Res Rev · February 2019 This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how ... Full text Link to item Cite

Implementing a Mandated Program Across a Regional Health Care System: A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies.

Journal Article Qual Manag Health Care · 2019 BACKGROUND: Rapid qualitative assessment was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Department ... Full text Link to item Cite

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program.

Journal Article Geriatrics (Basel) · December 2018 Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these n ... Full text Open Access Link to item Cite

Life Program: Pilot Testing a Palliative Psychology Group Intervention.

Journal Article J Palliat Med · November 2018 BACKGROUND: Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans. OBJECTIVES: This quality improvement project evaluat ... Full text Open Access Link to item Cite

The impact of wearable motion sensing technology on physical activity in older adults.

Journal Article Exp Gerontol · October 2, 2018 BACKGROUND AND PURPOSE: Physical activity provides substantial health benefits. Older adults are less physically active than the rest of the population, and interventions that promote physical activity are needed. In this meta-analysis, we investigate how ... Full text Link to item Cite

Systems-Based Practice to Improve Care Within and Beyond the Emergency Department.

Journal Article Clin Geriatr Med · August 2018 There is evidence that an emergency department (ED) visit signifies a period of vulnerability for older adults. Transition between the ED and community care can be fraught with challenges. There are essential elements for improved care transition from the ... Full text Link to item Cite

Internet Use and Technology-Related Attitudes of Veterans and Informal Caregivers of Veterans.

Journal Article Telemed J E Health · July 2018 BACKGROUND: Healthcare systems are interested in technology-enhanced interventions to improve patient access and outcomes. However, there is uncertainty about feasibility and acceptability for groups who may benefit but are at risk for disparities in techn ... Full text Link to item Cite

The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD).

Journal Article Adm Policy Ment Health · July 2018 The VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides landmark support for family caregivers of post-9/11 veterans. This study examines PCAFC support for veterans with and without PTSD and assesses whether program effect differs ... Full text Link to item Cite

Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults.

Journal Article Appl Clin Inform · July 2018 OBJECTIVE: Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algor ... Full text Link to item Cite

Effects of a Home-Based Telephone-Supported Physical Activity Program for Older Adult Veterans With Chronic Low Back Pain.

Journal Article Phys Ther · May 1, 2018 BACKGROUND: Chronic low back pain (CLBP) is highly prevalent in older adults, leading to functional decline. OBJECTIVE: The objective of this study was to evaluate physical activity (PA) only and PA plus cognitive-behavioral therapy for pain (CBT-P) among ... Full text Link to item Cite

Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol.

Journal Article Implement Sci · April 20, 2018 BACKGROUND: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, ... Full text Open Access Link to item Cite

Is objective mobility data associated with pharmacologic venous thromboembolism (VTE) prophylaxis use among hospitalized older adults?

Conference Journal of Hospital Medicine · April 10, 2018 Background: Clinical practice guidelines state that mobility is supposed to play an important role in determining use and duration of pharmacologic VTE prophylaxis. This study examines whether measured mobility levels relate to pharmacologic VTE prophylaxi ... Open Access Link to item Cite

Insomnia in United States military veterans: An integrated theoretical model.

Journal Article Clin Psychol Rev · February 2018 Marked by difficulty falling or staying asleep and/or poor sleep leading to daytime dysfunction, insomnia contributes to functional impairment, poor health, and increased healthcare utilization when left untreated. As many as two-thirds of Iraq and Afghani ... Full text Link to item Cite

Comprehensive Support for Family Caregivers of Post-9/11 Veterans Increases Veteran Utilization of Long-term Services and Supports: A Propensity Score Analysis.

Journal Article Inquiry · 2018 Family caregivers are an important component of the long-term services and supports (LTSS) system. However, caregiving may have negative consequences for caregiver physical and emotional health. Connecting caregivers to formal short-term home- and communit ... Full text Open Access Link to item Cite

Sleep, resilience, and psychological distress in United States military Veterans.

Journal Article Mil Psychol · 2018 Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the rela ... Full text Link to item Cite

Risk stratification for return emergency department visits among high-risk patients.

Journal Article Am J Manag Care · August 1, 2017 OBJECTIVES: To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and "Super User" status, defin ... Link to item Cite

Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED).

Journal Article J Am Geriatr Soc · July 2017 EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evalu ... Full text Link to item Cite

Evaluating the Impact of Medication Safety Alerts on Prescribing of Potentially Inappropriate Medications for Older Veterans in an Ambulatory Care Setting.

Journal Article J Pharm Pract · February 2017 Potentially inappropriate medications (PIMs) have been associated with poor outcomes in older adults. Electronic health record (EHR)-based interventions may be an effective way to reduce PIM prescribing. The main objective of this study was to evaluate cha ... Full text Link to item Cite

The Impact of Interventions that Integrate Accelerometers on Physical Activity and Weight Loss: A Systematic Review.

Journal Article Ann Behav Med · February 2017 BACKGROUND: Regular physical activity is important for improving and maintaining health, but sedentary behavior is difficult to change. Providing objective, real-time feedback on physical activity with wearable motion-sensing technologies (activity monitor ... Full text Link to item Cite

Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

Journal Article Int J Qual Health Care · February 1, 2017 QUALITY PROBLEM OR ISSUE: Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. INITIAL ASSESSMENT: Existing prescribing order entry processes were mapped at an initial Veterans A ... Full text Link to item Cite

Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study.

Journal Article BMC Geriatr · January 11, 2017 BACKGROUND: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for establishe ... Full text Open Access Link to item Cite

Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries.

Journal Article Pharmacoepidemiol Drug Saf · September 2016 BACKGROUND: Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropria ... Full text Link to item Cite

Identifying Patterns of Multimorbidity in Older Americans: Application of Latent Class Analysis.

Journal Article J Am Geriatr Soc · August 2016 OBJECTIVES: To define multimorbidity "classes" empirically based on patterns of disease co-occurrence in older Americans and to examine how class membership predicts healthcare use. DESIGN: Retrospective cohort study. SETTING: Nationally representative sam ... Full text Link to item Cite

Unrecognized Cognitive Impairment in Medically Complex Older Veterans

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · May 1, 2016 Link to item Cite

Overuse of pharmacologic venous thromboembolism prophylaxis in hospitalized older adults

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · May 1, 2016 Link to item Cite

Automated versus manual data extraction of venous thromboembolism risk among hospitalized older adults

Conference Journal of the American Geriatrics Society, Special Issue 2016: Annual Scientific Meeting Abstract Book · April 22, 2016 Full text Link to item Cite

Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments.

Journal Article Fed Pract · April 2016 The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUiPPED) program aimed to reduce potentially inappropriate medication prescribing to older adults at 5 VAMCs. ... Link to item Cite

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.

Journal Article J Gen Intern Med · March 2016 BACKGROUND: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes. OBJECTIVE: Our objective was to develop a conceptual model of co ... Full text Open Access Link to item Cite

Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department.

Journal Article J Manag Care Spec Pharm · January 2016 BACKGROUND: As the proportion of older adult patients who interface with the health care system grows, clinical pharmacy specialists (CPS) have a pivotal role in reducing potentially inappropriate medication (PIM) use in this population. OBJECTIVES: To (a) ... Full text Link to item Cite

Linkage of Laboratory Results to Medicare Fee-for-Service Claims.

Journal Article Med Care · November 2015 BACKGROUND: Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available. OBJECTIVE: The purpose of this study was to describe both the ... Full text Link to item Cite

Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study.

Journal Article J Gen Intern Med · August 2015 BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness. OBJECT ... Full text Link to item Cite

Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center.

Journal Article J Am Geriatr Soc · June 2015 Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with de ... Full text Link to item Cite

Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department, a Novel Multicomponent Interdisciplinary Quality Improvement Initiative.

Journal Article J Am Geriatr Soc · May 2015 Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED-targeted interventions aimed at reducing the use of potentially inappropriate medications (PI ... Full text Link to item Cite

Implementing EQUIPPED across five VA Emergency Departments

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2015 Link to item Cite

Research and Operations: Joining Forces to Improve Care for Veterans.

Journal Article N C Med J · 2015 The Veterans Health Administration's move to adopt a joint operations-research perspective in promoting clinical innovation in the health care system has led to an increasing number of researchers, clinicians, and policy leaders collaborating on quality im ... Full text Link to item Cite

Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program.

Journal Article J Am Geriatr Soc · November 2014 An important contributor to hospital-associated disability is immobility during hospitalization. Preliminary results from STRIDE, a clinical demonstration program of supervised walking for older adults admitted to the hospital with medical illness, are rep ... Full text Link to item Cite

Discharge information and support for veterans Receiving Outpatient Care in the Emergency Department: study design and methods.

Journal Article Contemp Clin Trials · November 2014 BACKGROUND: An explicit goal of Patient Aligned Care Teams (PACTs) within the Veterans Health Administration is to promote continuity of care in primary care clinics and thereby reduce Emergency Department (ED) utilization; however, there has been little r ... Full text Link to item Cite

Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES): study design and methodology.

Journal Article Contemp Clin Trials · July 2014 Within the Veterans Health Administration (VHA), the largest integrated health care system in the US, approximately 8.5 million Veteran patients receive informal care. Despite a need for training, half of VHA caregivers report that they have not received t ... Full text Link to item Cite

Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure.

Conference J Am Geriatr Soc · June 2014 OBJECTIVE: To use electronic health record (EHR) data to examine the association between inpatient medication exposure and risk of hospital readmission. DESIGN: Retrospective, observational study. SETTING: Tertiary and quaternary care academic health syste ... Full text Link to item Cite

Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department.

Journal Article J Am Geriatr Soc · April 2014 OBJECTIVES: To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions. DESIGN: Secondary analysis. SETTING: Medicare Current Benef ... Full text Link to item Cite

Health services use of older veterans treated and released from veterans affairs medical center emergency departments.

Journal Article J Am Geriatr Soc · September 2013 OBJECTIVES: To determine predictors of repeat health service use in older veterans treated and released from the emergency department (ED). DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Medical Center (VAMC) EDs. PARTICIPANTS: Nationally re ... Full text Link to item Cite

Transitional Care Partners: a hospital-to-home support for older adults and their caregivers.

Journal Article J Am Assoc Nurse Pract · August 2013 PURPOSE: To describe the development, implementation, and preliminary results of the Transitional Care (TLC) Partners, a clinical demonstration program that supports the transition from hospital to home of older veterans. DATA SOURCES: Hospital records of ... Full text Link to item Cite

Older veterans and emergency department discharge information.

Journal Article BMJ Qual Saf · October 2012 BACKGROUND: Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. ME ... Full text Link to item Cite

Emergency Department Prescribing and Continuity.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2012 Link to item Cite

Health care utilization before and after an outpatient ED visit in older people.

Journal Article Am J Emerg Med · January 2012 BACKGROUND: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. OBJECTIVES: ... Full text Link to item Cite

The Junior Faculty Laboratory: an innovative model of peer mentoring.

Journal Article Acad Med · December 2011 Mentoring in academic medicine has been shown to contribute to the success of junior faculty, resulting in increased productivity, career satisfaction, and opportunities for networking. Although traditional dyadic mentoring, involving one senior faculty me ... Full text Link to item Cite

Emergency department visits in Veterans Affairs medical facilities.

Journal Article Am J Manag Care · June 1, 2011 OBJECTIVE: To identify the frequency of, and risk factors for, repeat emergency department (ED) visits and hospitalizations following a treat-andrelease ED visit in patients from Veterans Affairs Medical Centers (VAMCs). STUDY DESIGN: Retrospective cohort ... Link to item Cite

Emergency department visits in veterans affairs medical facilities

Journal Article American Journal of Managed Care · June 1, 2011 Objective: To identify the frequency of, and risk factors for, repeat emergency department (ED) visits and hospitalizations following a treat-and-release ED visit in patients from Veterans Affairs Medical Centers (VAMCs). Study Design: Retrospective cohort ... Cite

Black-white disparity in disability: the role of medical conditions.

Journal Article J Am Geriatr Soc · May 2011 OBJECTIVES: To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. DESIGN: Cross-sectional analysis of a community ... Full text Link to item Cite

Emergency Department Discharge Information: What is Provided and Do Patients Understand?

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2011 Link to item Cite

Older Veterans Treated and Released from VAMC Emergency Departments.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2011 Link to item Cite

Older patients' understanding of emergency department discharge information and its relationship with adverse outcomes.

Journal Article J Patient Saf · March 2011 OBJECTIVES: To describe older patients' understanding of emergency department (ED) discharge information and to explore the relationship between understanding of ED discharge information and adverse outcomes. METHODS: Telephone interviews were conducted wi ... Full text Link to item Cite

Pilot study: individualized training for caregivers of hospitalized older veterans.

Journal Article Nurs Res · 2011 BACKGROUND: : The hospital-to-home transition represents a vulnerable time for older veterans who are more medically and socioeconomically challenged than the general population of older adults. OBJECTIVES: : The aim of this study was examine the feasibili ... Full text Link to item Cite

Special considerations of adherence in older adults

Journal Article · December 1, 2010 Optimizing medication adherence is a significant challenge for clinicians caring for older adults, particularly those with multiple chronic health conditions. Nearly half of all adults aged 65 or older take five or more medications regularly; however, adhe ... Full text Cite

Exploring patterns of health service use in older emergency department patients.

Journal Article Acad Emerg Med · October 2010 OBJECTIVES: Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership. MET ... Full text Link to item Cite

Emergency department discharge diagnosis and adverse health outcomes in older adults.

Journal Article J Am Geriatr Soc · October 2009 OBJECTIVES: To determine the relationship between the reason for an emergency department (ED) visit and subsequent risk of adverse health outcomes in older adults discharged from the ED. DESIGN: Secondary analysis of data from the Medicare Current Benefici ... Full text Link to item Cite

PROBLEMS IN TRANSITIONS OF CARE: A COURSE SESSION EXEMPLAR

Journal Article GERONTOLOGIST · October 1, 2009 Link to item Cite

Variability in Adverse Outcomes According to Emergency Department Discharge Diagnosis

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · March 1, 2009 Link to item Cite

Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department.

Journal Article J Am Geriatr Soc · September 2008 OBJECTIVES: To determine whether frail older adults, based on a deficit accumulation index (DAI), are at greater risk of adverse outcomes after discharge from the emergency department (ED). DESIGN AND SETTING: Secondary analysis of data from the Medicare C ... Full text Link to item Cite

Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department.

Journal Article Med Care · August 2008 BACKGROUND: Older adults who are discharged from the emergency department (ED) may be at risk for subsequent adverse outcomes; however, this has not been fully investigated in national, population-based samples. The goal of this study was to determine the ... Full text Link to item Cite

A quality improvement program to enhance after-hours telephone communication between nurses and physicians in a long-term care facility.

Journal Article J Am Geriatr Soc · June 2008 OBJECTIVES: To determine whether satisfaction of on-site nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN: Longitudinal quality improvement st ... Full text Link to item Cite

Quality of pharmacotherapy and outcomes for older veterans discharged from the emergency department.

Journal Article J Am Geriatr Soc · May 2008 OBJECTIVES: To determine whether suboptimal pharmacotherapy increases the risk of adverse outcomes in older adults discharged from the emergency department (ED). DESIGN: Retrospective, cohort study. SETTING: Academically affiliated Veterans Affairs Medical ... Full text Link to item Cite

Does lack of social support lead to more ED visits for older adults?

Journal Article Am J Emerg Med · May 2008 OBJECTIVE: The goals of this study were to (1) determine whether level of social support and living situation predicted emergency department (ED) use among older adults and (2) identify correlates of ED visits according to whether the patient was admitted ... Full text Link to item Cite

After-hours calls from long-term care facilities in a geriatric medicine training program.

Journal Article J Am Geriatr Soc · December 2007 OBJECTIVES: To describe after-hours telephone calls from nurses in long-term care (LTC) facilities to doctors in a geriatric medicine training program. DESIGN: Evaluation of 1,928 after-hours calls from LTC facilities over a 10-month period in 2005/06. SET ... Full text Link to item Cite

Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population.

Journal Article J Gen Intern Med · November 2007 BACKGROUND: An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system. OBJECTIVES: 1) To describe the frequency and type of adverse health ... Full text Link to item Cite

The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic.

Journal Article J Am Geriatr Soc · September 2007 OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this p ... Full text Link to item Cite

Adverse outcomes among older adults discharged from the emergency department.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2007 Link to item Cite

Development and implementation of the TrAC (Tracking After-hours Calls) database: a tool to collect longitudinal data on after-hours telephone calls in long-term care.

Journal Article J Am Med Dir Assoc · March 2007 INTRODUCTION: Effective telephone communication between long-term care (LTC) nurses and physicians is an integral part of high-quality care, yet little is known about this key aspect of LTC practice. The authors describe the development and implementation ... Full text Link to item Cite

Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

Journal Article J Am Med Dir Assoc · September 2006 OBJECTIVE: To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups. DESIGN: Descriptive pilot project. SETTING: Extended Care and Rehabilitation Center (ECRC), Durham VA Medical ... Full text Link to item Cite

Does social support predict emergency department utilization in older adults?

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2006 Link to item Cite

Offline testing of the ATHENA Hypertension decision support system knowledge base to improve the accuracy of recommendations.

Journal Article AMIA Annu Symp Proc · 2006 ATHENA-HTN is a clinical decision support system (CDSS) that delivers guideline-based patient-specific recommendations about hypertension management at the time of clinical decision-making. The ATHENA-HTN knowledge is stored in a knowledge-base (KB). Chang ... Link to item Cite

A systematic review of interventions to improve outcomes for elders discharged from the emergency department.

Journal Article Acad Emerg Med · October 2005 OBJECTIVES: To evaluate the evidence for interventions designed to improve outcomes for elders discharged from the emergency department (ED). METHODS: The study was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966-2005) ... Full text Link to item Cite

Quality improvement in longterm care telephone medicine.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2005 Link to item Cite

Medication review in the nursing home: Can stopping one drug make all the difference?

Journal Article Annals of Long-Term Care · February 1, 2005 Frail older adults frequently receive care at different locations in the health care system. Prescribing by multiple providers can lead to polypharmacy arid an increased risk of adverse drug events. A case is presented of a frail older patient with heart f ... Cite